Why is there blood loss?

[toby60]

Why are patients frequently anemic when they come in with a hip fracture? They frequently need a transfusion even before they have surgery to repair the fracture. Would someone please refresh me in the physiology of this? Thank-you:)

[sayitaintso]

i'm no nurse, not yet and i might be wrong or completely off but from what i have learned in anatomy is that blood is made in the red bone marrow, i would think that a hip fracture would cause the bone to break thus causing the blood to flow out if you are loosing more blood at a rate faster than it is being produced by the body then i guess thats where the anemia comes from

but someone might need to correct me.

[guest83140]

The most common causes of anemia in the elderly are chronic disease and iron deficiency.Even though the high prevalence of anemia in the elderly makes it a condition that clinicians might expect to find frequently, several features of anemia make it easy to overlook. The onset of symptoms and signs is usually insidious, and many elderly patients adjust their activities as their bodies make physiologic adaptations for the condition. Typical symptoms of anemia, such as fatigue, weakness and dyspnea, are not specific and in elderly patients tend to be attributed to advancing age. Pallor can be a helpful diagnostic clue, but pallor can be hard to detect in the elderly. Conjunctival pallor is a reliable sign, and its presence should prompt the clinician to order blood tests for anemia.Iron deficiency anemia, the second most common cause of anemia in the elderly, usually results from chronic gastrointestinal blood loss caused by nonsteroidal anti-inflammatory drug*induced gastritis, ulcer, colon cancer, diverticula or angiodysplasia. Chronic blood loss from genitourinary tract cancer, chronic hemoptysis and bleeding disorders may result in iron deficiency but are much less common causes. Older persons may become iron deficient because of inadequate intake or inadequate absorption of iron. Without blood loss, anemia takes several years to develop.

[Anna Flaxis, BSN, RN]

As glolilly posted (here is a link to her source of information: http://www.aafp.org/afp/20001001/1565.html), many elderly persons are chronically anemic. This may not be diagnosed until they come into the hospital setting with a fractured hip.

Blood loss associated with hip fracture occurs when the blood vessels in the area are ruptured and blood escapes from the intravascular compartment.

[steelcityrn, RN]

good answer above

[Guest27531]

Hip replacement procedures are extremely "bloody" procedures so it is not uncommon to provide blood transfusions as prophylaxis.

[ObtundedRN, BSN, RN]

Bone fractures cause blood loss. I believe they say you could have 2-3 liters of blood loss from a pelvic fx, and 1-2 from a femur fx. Those two can cause the most blood loss of any bone fx.

[Christen, ANP]

1. Patients who typically break their hips (or other large bones) are generally older adults. Older adults are higher risk for anemia of chronic disease or iron deficiency anemia than younger adults.

2. Hip fractures (and other large bone fractures) tend to bleed a lot just from the nature of a large bone fracture (though not always).

3. Hip replacements / large joint surgeries tend to bleed a lot, most patients loose at least 200 - 300 cc of blood minimally. Some can tolerate this, some can't, depending on their comorbidities.

:)

[canesdukegirl, BSN, RN]

I agree with all of the above posts. Also remember that you can't put a tourniquet on a hip :). We usually fix intertrochanteric fractures using a gamma nail, and we must ream the inside of the femur in order to get the nail down...that causes a heck of a lot of blood loss in itself.